During a presentation on prosthetics coordination through non-invasive BCI with EEG, it was shown that patients were able to do so through focusing on the imagined movements of their phantom limb. I'm wondering if this is more effective on patients who have had control over the corresponding limb where the motoric pathways are "familiarized" with the tasks compared to patients who are missing that limb from birth.
I'd appreciate any information/guidance on the subject!
Dear Zeynep.
Thank you for your interesting question.
I have doubts, in trying to answer. From my (scarse) experience on this issue, I notice that patients with congenital agenesia of limbs don't easily accept prosthetics, because they very soon get used to performing their normal tasks, the best they can, without any help.
I recently followed such a case in my practice, in a family where the single child was born with upper limb agenesia. As I observed both the mother and child, I imediately realised that the main problem came from the mother, who did not accept the child's physical disability. The child rejected every attempt to introduce prosthetics.and the longer the problem persisted, the wost it got. The mother got much better with careful psychologic help.
Dear Zeynep,
That is a very good question, which to the best of my knowledge is pretty unexplored territory. The issue with using BCI/BMI for patients with a congenital limb deficiency is that they will not have formed the appropriate neural pathways to control the limb - thus there is no chunk of the brain which is soley associated with controlling the missing limb.
That does not mean that alternate control strategies cannot be used, though.
Now, based on the very good results that the cochlear implants have had when implanted at a very young age (showing better results than adult implants), I would expect that a BMI when used consistently from a young age would give much better results. The issue with that, though, is that the child may not accept the BMI or prosthesis.
Thank you for your answer, Jack.
That's the opinion I was leaning towards. That having an existing corresponding region in the CNS that has learned to give those commands should make a difference. What I wasn't sure about though was whether if lacking this only extends the learning period, where these pathways would have to form from scratch (without difference in long term effectiveness) or indeed cause less people to benefit from it.
It is a really good point that age could be a major determinant given what we know about neuroplasticity and how it behaves with age. We could expect this learning period, where new pathways would have to form, to be significantly shorter at young ages.
And thank you both for bringing attention to the issue of compliance and psychological challenges. I imagine this plays a big role not only on how patients as well as their families approach different therapeutical options, but also on the construction of new studies to answer questions such as mine.
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